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Antenatal care (ANC) is a cornerstone of maternal and neonatal health. The World Health Organization recommends that pregnant women attend at least four ANC visits to monitor pregnancy progress, manage complications, and improve health outcomes for both mothers and babies.
While Kenya has made significant progress over recent decades, ANC coverage remains uneven across demographic and socioeconomic groups. Understanding which women are less likely to receive adequate ANC is crucial for informing targeted interventions and policy.
Objectives:
1. Explore how age and marital status relate to ANC behavior.
2. Visualize the proportion of women who had at least 4 ANC visits
during their last pregnancy.
3. Compare ANC utilization across education levels, residence, and
wealth quintiles.
4. Create summary tables and calculate mean ANC visits by education
level.
This analysis uses the most recent Kenyan Demographic and Health Survey (DHS) women’s recode dataset (KEIR72FL.DTA). The dataset includes detailed information on antenatal care utilization, household wealth, education, age, marital status, and place of residence. Data cleaning involved converting labelled variables to factors and filtering out records with missing values for antenatal care visits. A derived binary variable was created to classify whether a woman received at least four antenatal visits, following WHO recommendations. All analyses were conducted in R, using the tidyverse suite for data wrangling, ggplot2 for visualizations, and gtsummary and gt for table generation.
The presented figures and tables focus exclusively on the most recent pregnancy reported by each respondent to reflect the current state of care access and reduce recall bias related to earlier pregnancies. No weighting was applied in this descriptive analysis, in line with course guidance.
Interpretation:
A substantial majority of women — approximately 80% — reported having
four or more antenatal visits during their most recent pregnancy. This
finding demonstrates considerable progress compared to past decades.
Nevertheless, the persistence of a substantial minority of women without
adequate care highlights ongoing challenges. Barriers such as long
distances to facilities, indirect costs, and cultural beliefs may
continue to limit universal access to recommended services. Targeted
policy interventions are needed to reach these underserved
populations.
Interpretation:
The density plot shows that women aged between 25 and 35 are more likely
to have attended at least four ANC visits. This age group likely
includes women with greater health awareness, higher parity, and more
stable household circumstances. Conversely, younger women under 20 may
face additional challenges such as stigma, limited autonomy in
healthcare decisions, and financial dependence. Older women over 40 may
perceive fewer risks or have less engagement with formal services.
Age-specific strategies could help address these gaps.
Interpretation:
Education plays a significant role in ANC behavior. The chart
demonstrates a clear gradient: as education increases, the proportion of
women achieving adequate ANC rises substantially. Nearly all women with
higher education levels met the threshold, while those with no formal
education were far less likely to do so. Education likely improves
awareness, empowers decision-making, and correlates with better economic
opportunities. Strengthening education access for girls and women could
therefore have long-term benefits for maternal health.
Interpretation:
This figure shows a consistent socioeconomic gradient further modified
by residence. Urban women, especially in the wealthiest quintiles,
report the highest ANC coverage. In rural areas, even wealthier
households have lower coverage than their urban counterparts, reflecting
structural barriers such as fewer facilities and limited transportation.
The intersection of poverty and rural residence is particularly
disadvantageous and underscores the need for geographically targeted
interventions.
| Variable | no N = 3,0081 |
yes N = 11,9371 |
p-value2 |
|---|---|---|---|
| type of place of residence | <0.001 | ||
| urban | 698 (23%) | 4,464 (37%) | |
| rural | 2,310 (77%) | 7,473 (63%) | |
| highest educational level | <0.001 | ||
| no education | 1,054 (35%) | 1,734 (15%) | |
| primary | 1,508 (50%) | 6,333 (53%) | |
| secondary | 396 (13%) | 2,814 (24%) | |
| higher | 50 (1.7%) | 1,056 (8.8%) | |
| wealth index | <0.001 | ||
| poorest | 1,471 (49%) | 3,046 (26%) | |
| poorer | 622 (21%) | 2,422 (20%) | |
| middle | 441 (15%) | 2,186 (18%) | |
| richer | 310 (10%) | 2,155 (18%) | |
| richest | 164 (5.5%) | 2,128 (18%) | |
| respondent's current age | 29 (7) | 29 (7) | 0.9 |
| current marital status | <0.001 | ||
| never in union | 289 (9.6%) | 875 (7.3%) | |
| married | 2,213 (74%) | 9,310 (78%) | |
| living with partner | 182 (6.1%) | 624 (5.2%) | |
| widowed | 107 (3.6%) | 270 (2.3%) | |
| divorced | 65 (2.2%) | 229 (1.9%) | |
| no longer living together/separated | 152 (5.1%) | 629 (5.3%) | |
| 1 n (%); Mean (SD) | |||
| 2 Pearson’s Chi-squared test; Wilcoxon rank sum test | |||
Interpretation:
The summary table provides an overview of the distribution of key
variables across ANC utilization groups. Only about 15% of women without
education achieved the recommended number of visits, compared to nearly
90% among those with higher education. Wealth and residence also show
significant gradients. Married women were slightly more likely to
achieve adequate ANC. These patterns illustrate the intersection of
multiple disadvantage factors.
| Average Number of Antenatal Visits by Education Level | |
| highest educational level | mean_anc_visits |
|---|---|
| higher | 6.12 |
| secondary | 5.17 |
| primary | 4.73 |
| no education | 3.98 |
Interpretation:
This table highlights a strong association between education and the
intensity of ANC engagement. Women without any formal education averaged
about 4 visits, just at the threshold, while those with higher education
exceeded 6 visits. This reinforces the finding that education impacts
not only whether women meet minimum recommendations but also how
consistently they engage with antenatal services.
This analysis shows that while ANC coverage in Kenya is relatively high overall, inequities persist. Education, wealth, and residence all influence whether women receive adequate care.
Key Findings:
Limitations:
Future policies should prioritize improving access for disadvantaged groups, strengthening rural infrastructure, and investing in female education to sustain progress in maternal health.